Preterm delivery is a major healthcare problem affecting one in ten births, and is the leading cause of neonatal death and long term disability in the United States. Diabetes is a well-established risk factor for preterm delivery; in Hawaii approximately 20% of all women with Type 1, Type 2 and gestational diabetes deliver preterm. Ethnicity clearly plays a role .in both the rate of prematurity and the prevalence of diabetes; in Hawaii diabetes is particularly prevalent and a major health problem for Pacific Islanders. Periodontal disease also contributes to obstetric risk for preterm birth. Preliminary data obtained at our institution show Asian and Pacific Islander diabetics delivering preterm have significantly more periodontal pockets >4mm, more sites with attachment loss of > 3mm, and more sites that bleed after probing (a indicator of active disease) than non-diabetics delivering preterm or at term. Thus we hypothesize that periodontal disease is a potentially modifiable (treatable) cause of preterm birth among diabetic Asian and Pacific Islander women. This study has four main objectives: First, to determine which organisms are involved in periodontal disease in pregnant diabetic and non-diabetic Asian and Pacific Islander women. Second, acute infections involving the genitourinary tract or distant organs have been implicated in preterm birth. Thus, this study will obtain data regarding the role of maternal infections (periodontal disease, genitourinary tract infections, and perinatal CMV infection) in preterm birth in diabetic and non-diabetic Asian and Pacific Islander women. Third, the newborns will be examined after birth to obtain pilot data regarding the effect of maternal infection on perinatal mortality and neonatal morbidity (as assessed by the presence of chronic lung disease of prematurity and white matter damage in the newborns). Fourth, this proposal will allow us to obtain equipment (luminimager) and training on laboratory methods (creation of DNA probes, DNA-DNA macroarray techniques, Checkerboard immunoblot antibody techniques, TLR-2 and NF-kappaB activation assays) that will be required for an RO1 application.